[*Anya*]

Study regarding diet, salt, calorie intake and risk of stroke
January 2012 special issue of the Lancet Neurology.

In general, the 2 biggest threats to health and risk of stroke are overeating and excess salt, author Graeme J. Hankey, from Royal Perth Hospital, Perth, Western Australia, writes.

He writes that between 1970 and 2008, the incidence of stroke in high-income countries fell by 42%, probably as a result of increased public awareness about the dangers of high blood pressure, high cholesterol, and cigarette smoking.

But in poorer countries, the incidence of stroke increased by more than 100% during this period. This rise coincided with food and lifestyle changes associated with industrialization and urbanization.

In his review, Dr. Hankey examines the evidence linking nutrition and diet to the risk of stroke. He searched PubMed articles published in English from 1970 to October 2011, using a variety of search terms.

Dr. Hankey's review also revealed the following effects of individual foods and beverages on the risk of stroke:

Fish: 3 servings a day associated with a 6% lower risk of stroke
*Fruits and vegetables: >5 servings a day associated with a 26% lower risk of stroke
*Meat: Each daily serving associated with a 24% increased risk of stroke
*Reduced-fat milk: associated with a lower risk of stroke vs full-fat milk
*Chocolate: High consumption associated with a 29% lower risk of stroke
*Coffee: 3 to 4 cups per day associated with a 17% lower risk of stroke
*Tea: ≥3 cups per day associated with a 21% lower risk of stroke
*Sugar-sweetened beverages: high intake associated with increased obesity, diabetes, metabolic syndrome, and coronary heart disease
*Whole grains: high intake associated with a 21% lower incidence of cardiovascular events
*Rice: intake not associated with risk of stroke

"In the USA, modest, population-wide reductions in dietary salt of up to 3 g per day…are projected to reduce the annual number of new cases of stroke by 32,000 to 66,000, similar to the benefits of population-wide reductions in tobacco use, obesity, and cholesterol levels," he writes.

The National Stroke Association provides a comprehensive discussion for patients about stroke prevention.

Study Highlights
On the basis of a literature review, the reviewer noted the following findings:

**Although folic acid supplementation does not prevent stroke in populations with high folate intake, deficiency in regions of low folate intake may be a causal and treatable risk factor for stroke.
**Vitamin D deficiency is associated with hypertension, cardiovascular disease, and stroke, but to date, supplementation has not been shown to prevent cardiovascular events. Randomized trials are underway.
**Salt supplementation by 5 g per day is linked to a 23% increase in stroke risk.
Lowering salt consumption by 2 g per day is associated with a 20% decrease in cardiovascular events, and lower salt intake is also linked to blood pressure reduction.
**Calcium supplementation exceeding 0.5 g per day is linked to a 31% increase in the risk for myocardial infarction, does not prevent stroke, and may actually increase stroke risk.
**High intake of plant n-3 polyunsaturated fats is associated with a reduced risk for stroke.
**Marine n-3 polyunsaturated fat supplementation lowers cardiovascular events and death by 8%, but in a randomized trial, it did not reduce stroke risk.
**High intake of carbohydrates with high glycemic index and glycemic load is associated with increased blood glucose levels, body weight, and stroke mortality.
**High fiber intake is linked to lower blood pressure, blood glucose levels, and low-density lipoprotein cholesterol levels.
**High protein intake is not associated with stroke risk.
**High intake of an unhealthy diet was linked to an increased risk for stroke and a population-attributable risk for stroke of 19%.
**In women, a prudent diet or Dietary Approaches to Stop Hypertension (DASH)–style diet is associated with a lower risk for stroke, and a Western diet is linked with a higher risk for stroke.
**In women, the Mediterranean diet is associated with lower risks for stroke, cardiovascular disease, cardiovascular mortality, and all-cause mortality.

Lancet Neurology, Volume 11, Issue 1, Pages 66 - 81, January 2012
doi:10.1016/S1474-4422(11)70265-4